Department of Internal Medicine I, Comprehensive Heart Failure Center, University of Würzburg, Oberdürrbacher Strasse 6, Würzburg 97080, Germany.
BMC Geriatr. 2013 May 1;13:38. doi: 10.1186/1471-2318-13-38.
Laxatives are among the most widely used over-the-counter medications in the United States but studies examining their potential hazardous side effects are sparse. Associations between laxative use and risk for fractures and change in bone mineral density [BMD] have not previously been investigated.
This prospective analysis included 161,808 postmenopausal women (8907 users and 151,497 nonusers of laxatives) enrolled in the WHI Observational Study and Clinical Trials. Women were recruited from October 1, 1993, to December 31, 1998, at 40 clinical centers in the United States and were eligible if they were 50 to 79 years old and were postmenopausal at the time of enrollment. Medication inventories were obtained during in-person interviews at baseline and at the 3-year follow-up visit on everyone. Data on self-reported falls (≥2), fractures (hip and total fractures) were used. BMD was determined at baseline and year 3 at 3 of the 40 clinical centers of the WHI.
Age-adjusted rates of hip fractures and total fractures, but not for falls were similar between laxative users and non-users regardless of duration of laxative use. The multivariate-adjusted hazard ratios for any laxative use were 1.06 (95% confidence interval [CI], 1.03-1.10) for falls, 1.02 (95% CI, 0.85-1.22) for hip fractures and 1.01 (95% CI, 0.96-1.07) for total fractures. The BMD levels did not statistically differ between laxative users and nonusers at any skeletal site after 3-years intake.
These findings support a modest association between laxative use and increase in the risk of falls but not for fractures. Its use did not decrease bone mineral density levels in postmenopausal women. Maintaining physical functioning, and providing adequate treatment of comorbidities that predispose individuals for falls should be considered as first measures to avoid potential negative consequences associated with laxative use.
在美国，泻药是使用最广泛的非处方药物之一，但研究其潜在危险副作用的研究很少。之前没有研究过泻药使用与骨折风险和骨密度[BMD]变化之间的关系。
这项前瞻性分析包括 161808 名绝经后妇女（8907 名泻药使用者和 151497 名非泻药使用者），她们参加了 WHI 观察研究和临床试验。这些女性于 1993 年 10 月 1 日至 1998 年 12 月 31 日在美国的 40 个临床中心招募，符合条件的女性年龄在 50 至 79 岁之间，入组时已绝经。在基线和每 3 年一次的随访中通过个人访谈获得药物清单。使用自我报告的跌倒（≥2 次）、骨折（髋部和总骨折）数据。在 WHI 的 40 个临床中心中的 3 个中心测定基线和第 3 年的 BMD。
无论泻药使用时间长短，在年龄调整后，泻药使用者和非使用者的髋部骨折和总骨折发生率相似，但跌倒发生率不同。任何泻药使用的多变量调整后的危害比为跌倒 1.06（95%置信区间[CI]，1.03-1.10）、髋部骨折 1.02（95%CI，0.85-1.22）和总骨折 1.01（95%CI，0.96-1.07）。在 3 年的摄入后，在任何骨骼部位，泻药使用者和非使用者的 BMD 水平均无统计学差异。
这些发现支持泻药使用与跌倒风险增加之间存在适度关联，但与骨折无关。它的使用并没有降低绝经后妇女的骨密度水平。应考虑保持身体功能，并为易患跌倒的个体提供适当的合并症治疗，作为避免与泻药使用相关的潜在负面后果的首要措施。
